THE MANAGEMENT of plaque psoriasis has evolved significantly over the past two decades, with biologic treatments becoming increasingly central to care. A recent cross-sectional study, analysing data from 76,781 patients between 2007 and 2021, highlights a striking rise in the cost of these therapies. The average annual net treatment cost for first-line biologic medications increased from 21,236USD in 2007 to 47,125USD in 2021. This growth was accompanied by notable variations in the costs of different drugs within the same mechanistic classes.
Initially, tumour necrosis factor-α (TNF-α) inhibitors dominated the market; however, their use has declined in favour of interleukin (IL) inhibitors, particularly IL-23 and IL-17 inhibitors. By 2021, 42% of patients initiated treatment with IL-23 inhibitors and 21% with IL-17 inhibitors. Despite the greater variety of biologic options, the cost burden on the healthcare system and patients has worsened. The study estimated that if patients had initiated the lowest-cost biologic within each mechanistic class, the average annual cost in 2021 would have been 44% lower, at approximately 26,363USD.
Demographic factors also influenced prescribing patterns. Men, older patients, individuals living in the Northeast, and those without comorbid arthritis or inflammatory bowel disease were more likely to begin treatment with IL inhibitors rather than TNF-α inhibitors. The findings suggest a clear opportunity to achieve substantial cost savings through more strategic prescribing, either by opting for the lowest-cost treatments within each class or by ensuring that biologic prices better reflect their comparative effectiveness and safety.
This study underlines the urgent need for cost-conscious strategies in the management of plaque psoriasis, particularly given the growing reliance on high-cost biologic therapies to achieve effective disease control.
Reference
Rome BN, Han J, Mooney H, Kesselheim AS. Use and Cost of First-Line Biologic Medications to Treat Plaque Psoriasis in the US. JAMA Dermatol. Published online April 16, 2025. doi:10.1001/jamadermatol.2025.0669
